Co-existence of overweight/obesity and stunting: it's prevalence and associated factors among under - five children in Addis Ababa, Ethiopia

A community-based study to assess the prevalence and predictors of stunting among under-five children in Sheger City, Oromia, Ethiopia

Background

Stunting is a serious public health issue in Ethiopia. However, due to the scarcity of studies, little is known about the prevalence and predictors of stunting among children under the age of five in urban areas, especially those close to the capital city of the country (Addis Ababa). Thus, the aim of this study was to assess the prevalence of stunting and its predictors among children under the age of five in Lega Tafo Lega Dadi, Sheger City, Oromia, Ethiopia.

Methods

A community-based cross-sectional study was conducted on 566 children under the age of five using a systematic random sampling technique. Data were collected through face-to-face interviews, structured questionnaires, and anthropometric measurements. Afterward, the data were entered into EpiData (version 4.7) and exported to SPSS 26 for analysis. Anthropometric indices were calculated using WHO Anthro software (version 3.2.2). Bivariate and multivariable logistic regression analyses were performed to identify candidate variables and associated factors, respectively. An adjusted odds ratio (AOR) and its 95% confidence interval (CI) were used to assess the strength and significance of the association. A p-value of <0.05 was considered statistically significant. The goodness-of-fit for the model was assessed using the Hosmer-Lemeshow test.

Results

The prevalence of stunting was 18.9% (95% CI: 16, 22%) among under-five children in our study setting. Children whose mothers were daily laborers (AOR: 10.3), whose mothers' education level was primary school (AOR: 4.3), whose fathers were daily laborers (AOR: 4), who were born into families with an average birth interval of ≤24 months (AOR: 7.9), who were from families with a size ≥5 (AOR: 7.3), who had a history of diarrhea (AOR: 6.3), who had meals ≤3 times per day (AOR: 13.9), who were underweight (AOR: 2.8), who were breastfed for less than 2 years (AOR: 5.6), who had low dietary diversity (AOR: 6.3), and who experienced food insecurity (AOR: 3.6) were identified as the predictors of stunting in under-five children.

Conclusion

Approximately one-fifth of the under-five children were stunted in the study setting. Family occupational and educational status, average birth interval, family size, a history of diarrhea, meal frequency per day, underweight status, duration of breastfeeding, inadequate dietary diversity, and household food insecurity were all associated with stunting among the under-five children in the study setting.

The dual burden of malnutrition and its associated factors among mother-child pairs at the household level in Ethiopia: An urgent public health issue demanding sector-wide collaboration

INTRODUCTION

The coexistence of under-nutrition and over-nutrition in developing countries like Ethiopia results in the "mother-child pair double burden of malnutrition," with children experiencing either stunting, wasting or underweight while mothers face overweight or obesity. This poses a major public health challenge, prompting global health organizations to prioritize the issue and urge governments to act quickly. Despite this, there is a lack of research in Ethiopia on the double burden of malnutrition among mother-child pairs at the household level and the factors that worsen it.

OBJECTIVE

To assess the magnitude of double burden of malnutrition and its associated factors among mother-child pair at household level in East Ethiopia, 2022.

METHOD

A community-based cross-sectional study was conducted in East Ethiopia from April 15 to June 11, 2022. Multi-stage sampling was used, and data were collected through structured interviews. Child nutrition indicators were processed using WHO Anthro software. Binary logistic regression analysis was performed, calculating both crude and adjusted odds ratios to assess associations. Variables with a P value <0.05 in multivariable analysis were deemed statistically significant.

RESULT

The study revealed that coexisting malnutrition rates for (OM/SC), (OM/WC), and (OM/UC) were 8.5%, 7.0%, and 7.9% respectively. The double burden of malnutrition among mother-child pairs was found to be 12.3% [95% CI: 10.7, 13.7]. Marital status (divorced) [AOR = 1.80; 95% CI: 1.15, 2.82], child birth order (fourth or above) [AOD = 1.88; 95% CI:1.08, 3.26], number of under-five children in the household (five or more under-five children) [AOR = 1.58; 95% CI: 1.04, 2.39], poor maternal and child dietary diversity score [AOR = 2.76; 95% CI: 1.71, 4.45] and [AOR = 8.66; 95% CI: 4.85, 15.44], respectively, household food security status (food insecurity) [AOR = 3.68; 95% CI: 2.36, 5.75], and maternal stature (short stature) [AOR = 2.39; 95% CI: 1.65,3.45] were factors significantly associated with this burden.

CONCLUSION

The study emphasized the double burden of malnutrition affecting both mothers and children, a major public health concern in the area. Early-life nutrition is vital in preventing childhood under nutrition and adult obesity, leading to this dual burden. Breaking the cycle of malnutrition across generations is crucial. Policy makers should prioritize improving child nutrition and maternal health, stressing early-life nutrition to address the mother-child double burden of malnutrition.

Spatial variations and predictors of overweight/obesity among under-five children in Ethiopia: A geographically weighted regression analysis of the 2019 Ethiopian Mini Demographic and Health Survey

BACKGROUND

Overweight/ obesity among under-five children is an emerging public health issue of the twenty-first century. Due to the quick nutritional and epidemiological change, non-communicable diseases, premature death, disability, and reproductive disorders have grown in low-income countries. Besides, little attention has been given. Therefore, we aimed to explore spatial variations and predictors of overweight/obesity among under-five children in Ethiopia using a geospatial technique.

METHODS

A total weighted sample of 3,609 under-five children was included in the study. A cross-sectional study was conducted using a nationally representative sample of the 2019 Ethiopia Mini Demographic and Health Survey data set. ArcGIS version 10.8 was used to explore the spatial variation of obesity. SaTScan version 9.6 software was used to analyze the spatial cluster detection of overweight/obesity. Ordinary least square and geographically weighted regression analysis were employed to assess the association between an outcome variable and explanatory variables. A p-value of less than 0.05 was used to declare it statistically significant.

RESULTS

The spatial distribution of overweight/obesity among under-five children in Ethiopia was clustered (Global Moran's I = 0.27, p-value<0.001). The significant hot spot areas or higher rates of childhood obesity, were found in Southern Amhara, Northwest Somalia, Border of Harari, central Addis Ababa, Eastern SNNPR, and Northwestern Oromia region. In spatial SaT Scan analysis, 79 significant clusters of overweight/obesity were detected. The primary clusters were located in SNNPR, Oromia, and Addis Ababa (RR = 1.48, LLR = 31.40, P-value < 0.001). In the geographically weighted regression analysis, urban residence, cesarean section, rich households, and female children were statistically significant predictors.

CONCLUSIONS

Overweight or obesity among under-five children show spatial variations across Ethiopian regions. GWR analysis identifies cesarean section, wealth index, urban residence, and child sex as significant predictors. The Ministry of Health and Ethiopian Public Health Institute should target regions with these contributing predictors, promoting localized physical education, health education campaigns, and ongoing community monitoring to encourage active lifestyles and reduce sedentary behaviors among children.

Co-existence of maternal overweight/obesity, child undernutrition, and anaemia among mother-child pairs in Ethiopia

Ethiopia is currently known to be the most food-insecure country in sub-Saharan Africa, where childhood undernutrition remains endemic. While attention is increasingly being paid to childhood undernutrition in Ethiopia, a current surge of "triple burden of malnutrition" (TBM) has received less attention. The purpose of this study was to determine the prevalence of TBM and identify the associated factors in Ethiopia. Data were from the Ethiopian Demographic and Health Surveys (2005-2016) and a total of 20,994 mother-child pairs were examined in this study. The TBM was our primary outcome variable, which encompasses three types of nutritional problems-when a mother may be overweight/obese, while her child is stunted, wasted, or underweight plus has anaemia under the same roof. A multilevel logistic regression explored the individual- and community-level factors associated with TBM. Our study indicated that children under-five years of age were anaemic, stunted, wasted, and underweight [49.3% (95% CI: 48.7-49.9), 43.1% (95% CI: 42.4-43.7), 10.3% (95% CI: 9.9-10.7), and 27.6% (95% CI: 27.0-28.1)] respectively. The overall prevalence of TBM was 2.6% (95% CI: 2.39-2.83). Multilevel analyses revealed that TBM was more likely to occur among children aged 12-23 months (AOR: 2.54, 95% CI: 1.68-3.83), 24-35 months (AOR: 1.54, 95% CI: 1.03-2.29), children perceived by their mothers to be smaller than normal at birth (AOR: 1.94, 95% CI: 1.48-2.56), who experienced fever in the past 2 weeks (AOR: 1.58, 95% CI: 1.24-2.01), and lived in urban settings (AOR: 1.79, 95% CI: 1.13-2.86). Lower odds of TBM were reported among female children (AOR: 0.59, 95% CI: 0.47-0.72), and those who lived in rich households (AOR: 0.69: 95% CI: 0.49-0.98). TBM was found to be present in almost three percent of households in Ethiopia. Addressing the TBM through double-duty actions will be of critical importance in achieving malnutrition in all its forms in Ethiopia.

Association of Body Mass Index between Adolescents and their Parents in Mumbai and Kolkata: A Population-based Study

Introduction

Adolescent overweight and obesity as measured by body mass index (BMI) seem to be increasing at an alarming rate in urban populations. Parental BMI plays an important role in their adolescent's BMI. Overweight and obesity coexisting with undernutrition in adolescents is an important public health challenge in low- and middle-income countries (LMICs). We present results from a population-based study on adolescents' prevalence of BMI and its association with their parents' BMI in Mumbai and Kolkata, India.

Methods and materials

Multistage random sampling of households was used to select adolescents aged 12-14 years and one of their parents in 2019-2020. In Mumbai, 843 adolescents, and in Kolkata, 913 adolescents and one of their parents were interviewed independently by trained field investigators. Height and weight were measured using standardized procedures. Adolescents' BMI categories were defined using Centers for Disease Control and Prevention (CDC) recommendations. For parents, the BMI was categorized using Asian cut-off categories into underweight (BMI < 18.5), normal weight (BMI: 18.5-22.9), overweight (BMI: 23.0-27.0), and obese (BMI > 27.0). Multivariate logistic regression was used to determine the relationship between parental BMI and adolescents' BMI.

Results

In Mumbai, 15.7% and in Kolkata, 21.1% of adolescents were overweight or obese. Nearly 80% of mothers and 70% of other parents were either overweight or obese. The mothers of adolescents who were overweight or obese showed a high risk of their adolescent being overweight [odds ratio (OR): 4.16 (1.36-12.73)] or obese [OR: 18.53 (2.02-170.44)] in Mumbai and [OR: 4.45 (1.25-15.80)] and [OR: 8.81 (1.40-55.33)] in Kolkata respectively after adjusting for adolescent's gender and head of the household's highest level of educational attainment.

Conclusion

Adolescents' overweight/obesity status is strongly associated with their mothers' BMI in urban India. This association may reflect both genetic and environmental effects. The present study highlights the high prevalence of adolescent overweight and obesity in these urban populations and underscores how important it is to identify effective public health strategies for the primary prevention of childhood obesity.

Understanding the national evidence on the double burden of malnutrition in Ethiopia for the implications of research gap identifications: a scoping review

BACKGROUND

Owing to the unavoidable consequences of nutritional transition, the double burden of malnutrition (DBM) is an emerging public health problem. An increasing number of studies have found that Ethiopians face a DBM. However, country-level evidence has not yet been summarised using a scoping review study design.

OBJECTIVE

The main objective of this review was to map the national evidence on DBM in Ethiopia for the implications of research gap identifications.

ELIGIBILITY CRITERIA

The population, concept and context approach was used. All age groups, box sexes, all dates of publication and articles in English language focused on DBM conducted in Ethiopia were included.

SOURCES OF EVIDENCE

Primary research articles, systematic reviews, meta-analyses and scoping reviews searched from electronic databases such as PubMed, ScienceDirect, Cochrane Library, Wiley Online Library, Google Scholar and Google were the sources of evidence.

CHARTING METHODS

The Joanna Briggs Institute Reviewer's manual was used as a review methodology. The authors, publication year, region, study design, sample size, population group, measured outcomes and main findings were charted in a table.

RESULTS

A total of 35 articles met the inclusion criteria among 124 426 participants. The average summarised prevalence of DBM was 33.6%, with the average proportions of undernutrition and overnutrition at 21.5% and 12.1%, respectively. The major factors that influenced the DBM were categorised as child, maternal, adolescent, household and adult-related factors.

CONCLUSION

In Ethiopia, the overall prevalence of DBM is high, which makes one-third of the population affected by DBM. The foremost determinant factors that influenced the DBM were characterised as child, maternal, adolescent, household and adult-related factors. Therefore, a double-duty interventions should be used to address DBM, considering multilevel factors at the individual, community and societal levels.

PROTOCOL REGISTRATION

This review was registered on the figshare website on 28 February 2021, with DOI number https://doi.org/10.6084/m9.figshare.14131874. The review protocol was published with a DOI number http://dx.doi.org/10.1136/bmjopen-2021-050805.

The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors

BACKGROUND

Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0-59 months in Ethiopia.

METHODS

Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0-59 months were included in the study. Height-for-age z-scores (HAZ) less than - 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below - 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO.

RESULTS

The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94-2.85)] in 2005 to 0.87% [95%CI: (0.07-1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13-1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01-2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19-5.88)], and lived in families with 1-4 household members [AOR: 1.52, 95%CI: (1.02-2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42-7.95)].

CONCLUSION

The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.

Association between maternal stature and household-level double burden of malnutrition: findings from a comprehensive analysis of Ethiopian Demographic and Health Survey

BACKGROUND

Undernutrition among under-five children is one of the intractable public health problems in Ethiopia. More recently, Ethiopia faced a rising problem of the double burden of malnutrition-where a mother may be overweight/obese, and a child is stated as having undernutrition (i.e., stunting, wasting, or underweight) under the same roof. The burden of double burden of malnutrition (DBM) and its association with maternal height are not yet fully understood in low-income countries including Ethiopia. The current analysis sought: (a) to determine the prevalence of double burden of malnutrition (i.e., overweight/obese mother paired with her child having one form of undernutrition) and (b) to examine the associations between the double burden of malnutrition and maternal height among mother-child pairs in Ethiopia.

METHODS

We used population-representative cross-sectional pooled data from four rounds of the Ethiopia Demographic and Health Survey (EDHS), conducted between 2000 and 2016. In our analysis, we included children aged 0-59 months born to mothers aged 15-49 years. A total of 33,454 mother-child pairs from four waves of EDHS were included in this study. The burden of DBM was the primary outcome, while the maternal stature was the exposure of interest. Anthropometric data were collected from children and their mothers. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. The association between the double burden of malnutrition and maternal stature was examined using hierarchical multilevel modeling.

RESULTS

Overall, the prevalence of the double burden of malnutrition was 1.52% (95% CI 1.39-1.65). The prevalence of overweight/obese mothers and stunted children was 1.31% (95% CI 1.19-1.44), for overweight/obese mothers and wasted children, it was 0.23% (95% CI 0.18-0.28), and for overweight/obese mothers and underweight children, it was 0.58% (95% CI 0.51-0.66). Children whose mothers had tall stature (height ≥ 155.0 cm) were more likely to be in the double burden of malnutrition dyads than children whose mothers' height ranged from 145 to 155 cm (AOR: 1.37, 95% CI 1.04-1.80). Similarly, the odds of the double burden of malnutrition was 2.98 times higher for children whose mothers had short stature (height < 145.0 cm) (AOR: 2.98, 95% CI 1.52-5.86) compared to those whose mothers had tall stature.

CONCLUSIONS

The overall prevalence of double burden of malnutrition among mother-child pairs in Ethiopia was less than 2%. Mothers with short stature were more likely to suffer from the double burden of malnutrition. As a result, nutrition interventions targeting households' level double burden of malnutrition should focus on mothers with short stature to address the nutritional problem of mother and their children, which also has long-term and intergenerational benefits.